Advances in the treatment of anaphylaxis: intranasal and sublingual versus intramuscular epinephrine.

PURPOSE OF REVIEW: Epinephrine is universally considered the standard of care for the treatment of severe allergic reactions, including anaphylaxis, and, until recently, was preferentially recommended to be given intramuscularly in the thigh. However, newer routes of administration have been studied, with the intranasal route recently approved by regulatory agencies.

RECENT FINDINGS: Pharmacokinetic and pharmacodynamic studies suggest that noninjectable epinephrine routes (e.g., intranasal and sublingual) can achieve epinephrine levels on par with intramuscular administration via autoinjector.

SUMMARY: With new routes of epinephrine delivery being studied and approved for use, a new frontier of anaphylaxis management is emerging. There is potential that these routes may change how epinephrine is administered and severe reactions, including anaphylaxis, are treated.